Transcription of DRIVER'S LICENSE AND IDENTIFICATION CARD …
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NOTE: YOUR ADDRESS BELOW MUST BE CURRENT. THE POSTAL SERVICE WILL NOT FORWARD YOUR LICENSE OR ID NUMBER (optional)GENDER (check one) FEMALEMALEWEIGHT OF CITY OR COUNTY OF RESIDENCE COUNTY OFCITYSOCIAL SECURITY NUMBER (SSN)BIRTHDATE (mm/dd/yyyy)FULL LEGAL NAME (last, first, middle, suffix)EYE COLORHAIR COLORIF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE APPLICANT INFORMATIONSTREET ADDRESS APT NO. CITY STATE ZIP CODEHEIGHT FT.
I certify and affirm that I am a resident of Virginia, that all information presented in this application is true and correct, that any documents I have presented to
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